Learning Objectives

• Identify the three anatomical parts of the gallbladder and their surface landmarks.
• Map the biliary tree from the hepatocytes to the major duodenal papilla.
• Master the cystic artery and its origin within the Calot’s triangle.
• Distinguish between cholecystitis, choledocholithiasis, and cholangitis.

Anatomical Structure

The gallbladder is a pear-shaped, intraperitoneal sac (30-50ml) located in a fossa on the visceral surface of the liver, between the right and quadrate lobes.

• Fundus: The rounded end that projects inferior to the liver border. It is located at the intersection of the right mid-clavicular line and the 9th rib.
• Body: The main storage portion, related to the duodenum and transverse colon.
• Neck: The narrow part is continuous with the cystic duct. It features Hartmann’s Pouch, a mucosal fold where gallstones frequently lodge.

The Biliary Tree: Pathway of Bile

Bile is produced in the liver, stored in the gallbladder, and secreted into the second part of the duodenum.

1. Right and Left Hepatic Ducts unite to form the Common Hepatic Duct.
2. The Cystic Duct (from the gallbladder) joins the Common Hepatic Duct.
3. This union forms the Common Bile Duct (CBD).
4. The CBD joins the Main Pancreatic Duct to form the Ampulla of Vater.
5. Bile enters the duodenum through the Major Duodenal Papilla, regulated by the Sphincter of Oddi.

Vasculature & Innervation

• Arterial Supply: The Cystic Artery, usually a branch of the Right Hepatic Artery.

  Clinical Note: This artery is found within the Cystohepatic Triangle (of Calot) during surgery.

• Venous Drainage: Cystic veins drain into the Portal Vein.
• Innervation:
  • Parasympathetic (Vagus): Contraction of the gallbladder.
  • Hormonal: Cholecystokinin (CCK) is the primary stimulus for gallbladder contraction after a fatty meal.

Clinical Relevance: Gallstone Pathologies

Understanding the location of a stone is key to diagnosis:

Activity